Anterior Cruciate Ligament Surgery: Risk Factors for Development of Osteoarthritis: What Can We Do to Prevent It?

Abstract

The anterior cruciate ligament (ACL) injury is well known as a risk factor for knee osteoarthritis (OA) with or without reconstruction. Oiestad et al. [36] reported the prevalence of knee OA of ACL-injured subjects treated surgically or nonsurgically in their systematic review. They concluded that the highest rated studies on methodology reported low prevalence of knee OA for individuals with isolated ACL injury (0–13 %) and a higher prevalence for ACL-injured subjects combined with meniscus and/or medial collateral ligament injury (21–48 %). Their group also reported prevalence of OA at 10–15 years’ follow-up after ACL reconstruction with bone-patella tendon-bone (BTB) autograft [37]. The total prevalence of radiographic knee OA after ACL surgery was 74 % (the Kellgren and Lawrence -K&L- grade over 2), and subjects with combined injury had significantly higher prevalence of OA compared with isolated injury (80 and 62 %, K&L grade over 2), but no significant group differences were shown for symptomatic radiographic knee OA (46 and 32 % defined as K&L grade over 2 with knee pain during past 4 weeks). In addition, this study showed that radiographic knee OA (including both isolated and combined ACL injury, BTB, and hamstring tendon autograft) was detected in 71 % (K&L grade over 2), and 24 % showed moderate or severe radiographic knee OA (K&L grades 3 and 4) [39].